Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Georgia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Georgia only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Georgia (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Pulmonary And Sleep Medicine P C (NPI 1265461172)

Pulmonary And Sleep Medicine P C is a specialist provider located in Dalton, Georgia. This profile covers 0 Medicare and 14 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pulmonary And Sleep Medicine P C
Address	1420 Mineral Springs Rd
City	Dalton
State	GA
ZIP	30720
Taxonomy	Specialist
NPI Enumerated	July 2, 2006

Payer Source	Total Paid
Medicaid	$332.7K
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	3,220	$40	$115.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	2,310	$20	$46.3K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	1,710	$20	$37.7K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	1,710	$20	$35.9K
94727	The provider performs a pulmonary function test, or PFT, to assess the patient’s lung volumes using gas dilution or washout techniques that compare a known concentration of an inhaled gas with the…	1,710	$20	$27.4K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	100	$250	$25.4K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	70	$260	$19.2K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	220	$60	$11.9K
94618	The provider performs pulmonary stress testing to evaluate lung function and to diagnose certain lung disorders. The stress component may include a six–minute walk test or other form of exercise.	380	$10	$4.9K
99406	The provider counsels the patient on how to stop tobacco use. The counseling lasts more than three minutes, up to 10 minutes.	920	$1	$3.7K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Georgia providers billing the same CPT/HCPCS codes.

Claims Volume vs. Georgia Distribution

Pulmonary And Sleep Medicine P C — 3 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	8	10	360	$1,510	$1.6M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	254	920	370	$60	$360.6K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	164	820	390	$70	$245K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	82	230	100	$110	$97.1K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	3	10	60	$490	$49.5K
94010	The provider or technician administers a spirometry test to assess the patient's respiratory function. The spirometer is attached to a computer that records the total and timed vital capacity…	18	30	70	$30	$22.5K
95012	The provider performs a test involving nitric oxide exhaled by a patient into a nitric oxide monitoring system. The test helps with checking the level of inflammation in the airways of a patient who…	7	10	180	$20	$18.6K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	3	30	140	$40	$15.1K
94727	The provider performs a pulmonary function test, or PFT, to assess the patient’s lung volumes using gas dilution or washout techniques that compare a known concentration of an inhaled gas with the…	1	10	70	$10	$5.7K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	1	30	80	$20	$5K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Highland Rivers Community Service Board	GA	Community/Behavioral Health Agency	$0	$44.1M
White's Pediatrics	GA	Pediatrics Physician	$0	$25.1M
Family And Children First LLC	GA	Community/Behavioral Health Agency	$0	$19.5M
Hamilton Physician Group Inc	GA	Cardiovascular Disease Physician	$0	$5.9M
Pediatrics Of Dalton, PA	GA	Specialist	$0	$5.5M
Dalton Ear Nose & Throat Associates	GA	Otolaryngology Physician	$0	$4M
Skin Cancer & Cosmetic Dermatology Center, PC	GA	Dermatology Physician	$0	$3.4M
John Chung	GA	MOHS-Micrographic Surgery Physician	$2.5M	$0
Hamilton Emergency Medical Services	GA	Land Ambulance	$1.2M	$0
Hosam Saad-naguib	GA	Hematology & Oncology Physician	$1M	$0

Pulmonary And Sleep Medicine P C — Billing Profile & Reimbursement Data

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Pulmonary And Sleep Medicine P C — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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